Tracheostomy Complications

Mucus plugs are the most common cause of respiratory distress for children with
tracheostomies. Symptoms of a mucus plug include
resistance when trying to suction or bag and/or signs of respiratory distress.

Suction trach or change trach tube as needed for respiratory distress. The tube may
have become blocked with dried secretions or blood. If symptoms do not clear with suction
or trach change, call the doctor or 911, go directly to the emergency room, or call an
ambulance.

Very small amounts of bleeding (pink or red streaked mucus) often occurs as a result of
routine suctioning. This bleeding can be managed with close observation and by modifying
the care that might have caused the problem.

Possible Causes of Minor Bleeding

Irritation to the fragile tissue around the stoma

Insufficient humidity to the airway

Too frequent, deep or vigorous suctioning

Suction pressure that is too high (Suction machine pressure for small children 50-100mm
Hg, for older children/adults 100-120mm Hg)

Infection

Trauma, manipulation of trach

Foreign object in the airway

Excessive coughing

Call your doctor, emergency services, or go directly to your local emergency room for a
significant amount of bright red bleeding from the tracheostomy.

Children with tracheostomies are at high risk for respiratory infections. The trach
tube bypasses the natural defenses (nasal hair and mucus membranes) of the upper airway
that filter out dust and bacteria. Also, monitor for local infections at the stoma site. Hand washing before any trach care is one of the best defenses against infection.

Symptoms of Infection

Yellow or green secretions (may be pink/blood tinged)

Thicker mucus

Increased amount of mucus

Redness, rash and/or inflamed at stoma site

Bleeding at stoma site

Foul odor

Elevated temperature (fever)

Congested lung sounds

Increased respiratory effort or change in respiratory rate

Listlessness

Discomfort with trach care, tender at stoma site

Tracheitis
A dry tracheitis is an infection in the trachea that may develop if
humidification of the airway is inadequate.

There should always be two spare trachs with the child at all times, the childs
size and one size smaller for emergency replacement. If the regular size does not fit,
then the smaller size will keep the airway patent (open). Keep two trach tubes taped at
the head of the childs bed and in your travel bag. Always keep blunt-nosed scissors
handy to cut trach ties.

Opening the airway is always the first priority. If a spare trach tube is not handy,
replace the one that came out. Later, when the situation is under control, you can replace
it with a clean trach tube.

If you cannot reinsert the tube, observe the child to see if he/she can breathe through
the stoma itself. This may be possible if the stoma is well healed and fairly large.
The child may also be able to breathe through the nose and mouth if there is no
severe obstruction above the trach site. Go immediately to the emergency room.

Children with trachs are often on some type of monitoring device (apnea monitors or
pulse oximeters) when not directly supervised (naps and bedtime), to alert caretakers in
the event of a problem such as accidental decannulation or a mucus plug. Ask your
physician about these devices and if they would be appropriate for your child.

Cardiac Apnea Monitor

A less sophisticated but useful alarm is to attach bells to the child's legs and/or
arms. However, be sure that the bells cannot be removed or swallowed!

It may be comforting to have the child sleep in the same room with you for closer
monitoring, particularly infants and young children.

Caring for a child with a tracheostomy may cause anxiety. Try not to let the child see
that you are anxious.

Try not to make a big deal about the trach, particularly if the child touches the trach
tube. They will learn very quickly that by touching or pulling the trach tube, they
receive attention, which tends to reinforce the behavior.

Once children develop a pattern of pulling on the trach tube, it is more difficult to
control, especially for young children and children with developmental disabilities. A
Tracheostomy Collar may be helpful in preventing the child from pulling out the
tracheostomy tube. A trach collar is like a belt with a hole in the center for the trach
tube opening, then it fastens in the back of the neck. Check with your doctor or medical
supply vendor.

All parents and caregivers should be trained in cardiopulmonary resuscitation (CPR). In
fact, infant and child CPR classes for parents are required before a baby can be
discharged from many Neonatal Intensive Care Units (NICU). Although it is not the purpose
site to teach CPR, I would like to point out some important differences when
delivering CPR to an infant or child with a tracheostomy tube.

If the Child is Not Breathing

Open the airway using the chin lift, but do not hyperextend the neck.

Suction the trach tube.

If the trach has an inner cannula, remove the inner cannula and suction slightly past
(mm) the length of the trach tube.

Change the trach tube if plugged or dislodged.

Give two gentle puffs of air into the trach tube using an Ambu bag (breathing bag) with
trach adapter or mouth to trach technique.

If air leaks from nose and mouth, hold them closed.

If the tube is obstructed or lost, it may be possible
to give ventilation by sealing your mouth over the stoma and blowing or
place the face mask of ambu bag over the stoma (gently, just enough to cause
the childs chest to expand).

If the child's airway is not obstructed, you can use mouth to mouth resuscitation by
closing the stoma with your finger.